呼吸器・呼吸器内科

Introduction: While asthma mortality and hospitalizations have decreased substantially over the past two decades, asthma prevalence has increased, and a number of individuals still present with severe asthma. As intensive care unit (ICU) admissions can be used as a marker for severe asthma, there is utility in continuing to monitor ICU trends and the descriptive profile of individuals admitted to the ICU.

Methods: Health administrative population data from Ontario, Canada, were used to describe ICU admission trends by age group from 2003 to 2012 and the characteristics of those admitted to ICU. Descriptive analyses were performed for both hospitalized patients and ICU patients for age, sex, rurality, neighborhood income quintile and comorbidities.

Results: ICU admission rates per 100,000 asthma population decreased steadily over time (56.4 in 2003; 31.1 in 2012), but increased in the 0-4 (73.9 in 2003; 85.9 in 2012) and 5-14 (11.1 in 2003; 18.8 in 2012) age groups. Compared to individuals who were hospitalized only, a greater proportion of older individuals, females, children with other respiratory conditions, and adults with acute myocardial infarction were admitted to the ICU.

Conclusions: While the overall rate of ICU admissions has decreased over time, it has increased in children aged 0-14. This study identified high risk groups who are more likely to be admitted to the ICU. These individuals may benefit from targeted interventions to improve asthma control and reduce their future risk of admission to the ICU.

The assessment of public opinion’s belief represents an important instrument in order to evaluate the best actions aimed at the containment of all conditions of substantial social impact.

Aim: Aim of the study was to investigate the current awareness and the perception of COPD in the Italian general population.

Methods: the opinion survey was carried out by means of the Computer Assisted Telephone Interviewing Technique (CATI). A pre-determined set of ten simple closed questions aimed to investigate the subjects’ basic knowledge and awareness on COPD was the operational instrument.

Results: respondents were 1,170 individuals, representative of the national general population. The final redemption rate of the survey was 14%, such as one successful interview out of 7 attempts: this result is clearly mirroring the poor appeal of COPD in the public opinion. The observed prevalence of COPD was very close to that officially known (5-6%). Both the public knowledge and awareness of COPD determinants proved quite confused, except for smoking. The convincements of the majority of respondents were inconsistent, particularly as concerning the intrinsic severity; the duration, and the progression of COPD. People proved particularly unaware of the social and the economic impact of COPD. “Chronic Obstructive Pulmonary Disease” represented a terminology very difficult for espondents: they frequently stopped the call because they did not understand and feared these terms. The final suggestion is that the public belief on COPD still is limited to a few convincements emotionally driven, but not based on a true knowledge of the disease, particularly within younger individuals, who are the most unaware, but also the major responsible of the future burdening of COPD.

Serratia marcescens is an opportunistic, gram negative, nosocomial pathogen which belongs to family, Enterobacteriaceae. It was originally considered to be an innocuous, non-pathogenic, saprophytic water organism. The main risk factors for bacteraemia/sepsis which is caused by Serratia is hospitalization, placement of intravenous catheters, intraperitoneal catheters and urinary catheters and prior instrumentation of the respiratory tract. An important characteristic is its ability to produce a beta-lactamase which confers resistance to the broad spectrum beta lactam antibiotics, which often complicates the therapy. Here we present a case of pneumonia caused by Serratia marcescens in a 3 year old child, without having any significant predisposing factors.

Scrub typhus is a bacterial infection caused by Orientia tsutsugamushi. The disease is prevalent in a very large geographical area and usually presents with undifferentiated febrile illness. Pulmonary manifestations impart further challenge for clinician due to nonspecific clinical presentation, lack of sensitive and specific diagnostic tests and high incidence of complications and mortality, if not treated timely. Proper elucidation of underlying pathogenetic mechanisms and immune response is essential to understand the sequence of events, clinical implications, prognostic factors and prospects for vaccine development for this potentially fatal infection.

Pulmonary alveolar proteinosis (PAP) is a rare disease whose etiology is not completely known and is characterized by deposition of surfactant proteins and phospholipid-rich acid Schiff (PAS) (+) material in alveoli and bronchioles [1]. One third of the patients die because of progressive hypoxemia and secondary infections while a small proportion does not respond to treatment and subsequently fibrosis develops. In this report, a case of pulmonary alveolar proteinosis admitted to intensive care unit due to progressive hypoxemia and treated with bilateral TLL along with veno-arterial (v-a) extracorporeal membrane oxygenation (ECMO) is presented.

Objective: to study the effect of the glucocorticoid, methylprednisolone (MP), in lipopolysaccharide (LPS)-induced fractalkine (FKN) expression in HK-2 cells and to determine the role of NF-κB in this signaling pathway.

Methods: HK-2 cells were stimulated by LPS to set up an in vitro inflammation model. The concentration of FKN in cell culture supernatant was measured by ELISA. FKN and p65 mRNA expression were detected by RT-PCR. FKN, p65 protein expression and the activity of the NF-κB were detected by immunofluorescence staining and western blotting. The effect of MP and SC-514 (a selective and reversible inhibitor of IKK beta) in FKN expression and NF-κB activation induced by LPS were evaluated.

Results: LPS induced FKN expression and secretion in HK-2 cells occurred in a time- and dose-dependent manner and correlated with the activation of NF-κB. MP was able to inhibit FKN expression and secretion as well as the NF-κB induced activation of LPS, whereas SC-514 abolished this effect.

Conclusions: MP inhibited FKN expression induced by LPS through the NF-κB pathway in human renal tubular epithelial cells in vitro. Use of HK-2 cells to study the renal inflammatory process will allow the further elucidation of the pathways involved in kidney disease.

Lymphangioleiomyomatosis is a rare progressive cystic lung disease affecting young women in childbearing ages. It generally presents with respiratory manifestations varying from simple cough to recurrent pneumothorax and chylothorax. There is known female gender predominance, highlighting the important roles for sex hormones in the pathophysiology and progression of this disease. In this case report we describe a 26 year old woman with history of dyspnea and pneumothorax during her molar pregnancy.

Interferon is essential in human defense against influenza virus. The non-structural gene segment (NS) of influenza virus has a critical role in counteracting human interferon-mediated antiviral responses. The second wave of 1918 H1N1 Spanish influenza pandemic was characterized by an enhanced mortality and a W-shaped mortality age distribution. In contrast to the U-shaped mortality-age distribution that targeted the very young and elderly during the first wave, young adult population were also affected during the second wave. The NS of the 1918 H1N1 Spanish influenza virus (1918PV) isolated during the second wave contributes to the virulence of 1918PV. This unique NS of 1918PV is able to inhibit human interferon production at both the pre-transcriptional and post-transcriptional level and induce cytokine dysregulation. The NS of 1918PV has entered the swine population in 1918 and re-emerged in the 2009 novel H1N1 influenza A pandemic virus (2009PV). Both seasonal and pandemic novel H1N1 influenza A viruses produced a W-shaped mortality age distribution. Information from the 2009 novel H1N1 Influenza A pandemic may help to reconstruct the mysterious surge in mortality during the second wave in the 1918 H1N1 Spanish influenza A pandemic. The W-shaped mortality-age distribution of 2009PV indicates the importance of a universal influenza vaccination policy for public protection. The high incidence of cytokine dysregulation and Streptococcus pneumoniae co-infection in hospitalized patients reflects the importance of pneumococcal vaccination and the development of immunomodulating agents that can control influenza-induced cytokine dysregulation.

Background: Knowledge of the superior vena cava syndrome has been dated back to the 1757 work of William Hunter in the field of syphilis.

Method: The present paper deals with the history of the syndrome from 1833 to 1892 with reference to lung cancer.

Results: The old authorities provided such detailed data that lines for future research are derivable. Thus, much as expectations from the theory of lung cancer spread are those of superabundant secondaries, the reality is that particular cases exhibit secondaries which are merely adjacent to the main tumor.

Conclusion: It is hypothesized that, as this is Nature’s own model, translational laboratories should explore employing it as a human model.